REPORT OF THE COMMISSION ON

ENDING
CHILDHOOD
OBESITY
REPORT OF THE COMMISSION ON

ENDING
CHILDHOOD
OBESITY
WHO Library Cataloguing-in-Publication Data

Report of the commission on ending childhood obesity.

1.Pediatric Obesity – prevention and control. 2.Child. 3.Feeding Behavior. 4.Food Habits. 5.Exercise. 6.Diet. 7.Health Promotion.
8.National Health Programs. I.World Health Organization.

ISBN 978 92 4 151006 6 (NLM classification: WS 130)

© World Health Organization 2016

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CONTENTS

v Glossary and definitions

vi Executive summary

2 Introduction

8 Guiding principles

12 Strategic objectives

16 Recommendations

33 Actions and responsibilities

for implementing the recommendations

38 Monitoring and accountability

40 Conclusions

42 References

46 ANNEX 1: The Commission on Ending Childhood Obesity

48 ANNEX 2: Commissioners
iv
GLOSSARY AND
DEFINITIONS
BMI Body mass index = weight (kg)/height (m2).

BMI-FOR-AGE BMI adjusted for age, standardized for children.

CHILDREN Those less than 18 years of age.1

INFANTS Those less than 12 months of age.

HEALTHY FOODS Foods that contribute to healthy diets if consumed in appropriate

amounts.2

OBESITY From birth to less than 5 years of age: weight-for-height more

than 3 Standard Deviation (SD) above the WHO Child Growth
Standards median.3

From age 5 to less than 19 years: BMI-for-age more than 2 SD

above the WHO growth reference median.4

OBESOGENIC An environment that promotes high energy intake and sedentary

ENVIRONMENT behaviour.

This includes the foods that are available, affordable, accessible

and promoted; physical activity opportunities; and the social
norms in relation to food and physical activity.

OVERWEIGHT From birth to less than 5 years of age: weight-for-height more

than 2 SD above WHO Child Growth Standards median.3

From age 5 to less than 19 years: BMI-for-age more than 1 SD

above WHO growth reference median.4

UNHEALTHY FOODS Foods high in saturated fats, trans-fatty acids, free sugars or salt

(i.e. energy-dense, nutrient-poor foods).

YOUNG CHILDREN Those less than 5 years of age.

1
Convention on the rights of the child, Treaty Series, 1577:3(1989): PART I, Article 1 defines a child as every human being below the age of eighteen years unless, under the law
applicable to the child, majority is attained earlier. The World Health Organization (WHO) defines adolescents as those between 10 and 19 years of age. The majority of adolescents
are, therefore, included in the age-based definition of “child”, adopted by the Convention on the Rights of the Child, as a person under the age of 18 years.
2
http://www.who.int/mediacentre/factsheets/fs394/en/.
3
http://www.who.int/childgrowth/standards/technical_report/en/.
4
http://www.who.int/nutrition/publications/growthref_who_bulletin/en/. The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the
recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5–19-year age group.

v
EXECUTIVE
SUMMARY
Childhood obesity is reaching
alarming proportions in many
countries and poses an urgent
and serious challenge. The
Sustainable Development Goals,
set by the United Nations in
2015, identify prevention and
control of noncommunicable
diseases as core priorities. Among
the noncommunicable disease
risk factors, obesity is particularly
concerning and has the potential
to negate many of the health
benefits that have contributed to
increased life expectancy.
The prevalence of infant,
childhood and adolescent obesity
is rising around the world.
Although rates may be plateauing
in some settings, in absolute
numbers there are more children
who are overweight and obese in
low- and middle-income countries
than in high-income countries.
Obesity can affect a child’s
immediate health, educational
attainment and quality of life.
Children with obesity are very
likely to remain obese as adults
and are at risk of chronic illness.
Progress in tackling childhood
obesity has been slow and
inconsistent. The Commission
vi
on Ending Childhood Obesity
was established in 2014 to
review, build upon and address
gaps in existing mandates and
strategies. Having consulted
with over 100 WHO Member
States and reviewed nearly 180
online comments (see Annex 1),
the Commission has developed
a set of recommendations to
successfully tackle childhood and
adolescent obesity in different
contexts around the world.
Many children today are
growing up in an obesogenic
environment that encourages
weight gain and obesity.
Energy imbalance has resulted
from the changes in food type,
availability, affordability and
marketing, as well as a decline
in physical activity, with more
time being spent on screen-
based and sedentary leisure
activities. The behavioural and
biological responses of a child
to the obesogenic environment
can be shaped by processes
even before birth, placing an
even greater number of children
on the pathway to becoming
obese when faced with an
unhealthy diet and low physical
activity.
No single intervention can halt
the rise of the growing obesity
epidemic. Addressing childhood
and adolescent obesity requires
consideration of the environmental
context and of three critical
time periods in the life-course:
preconception and pregnancy;
infancy and early childhood; and
older childhood and adolescence.
In addition, it is important to treat
children who are already obese,
for their own well-being and that of
their children.
Obesity prevention and treatment
requires a whole-of-government
approach in which policies across
all sectors systematically take
health into account, avoid harmful
health impacts, and thus improve
population health and health
equity.
The Commission has developed
a comprehensive, integrated
package of recommendations to
address childhood obesity. It calls
for governments to take leadership
and for all stakeholders to
recognize their moral responsibility
in acting on behalf of the child
to reduce the risk of obesity. The
recommendations are presented
under the following areas.
 PROMOTE INTAKE OF
HEALTHY FOODS

WEIGHT PROMOTE
MANAGEMENT PHYSICAL ACTIVITY
1

6 2

ENDING
CHILDHOOD
OBESITY
5 3

HEALTH, NUTRITION PRECONCEPTION AND

AND PHYSICAL PREGNANCY CARE
ACTIVITY FOR SCHOOL-
AGE CHILDREN

EARLY CHILDHOOD
DIET AND PHYSICAL
ACTIVITY

vii
RECOMMENDATIONS

1 IMPLEMENT COMPREHENSIVE PROGRAMMES

THAT PROMOTE THE INTAKE OF HEALTHY FOODS
AND REDUCE THE INTAKE OF UNHEALTHY
FOODS AND SUGAR-SWEETENED BEVERAGES BY
CHILDREN AND ADOLESCENTS.

1.1 Ensure that appropriate and context-specific

nutrition information and guidelines for
both adults and children are developed and
disseminated in a simple, understandable and
accessible manner to all groups in society.

Implement an effective tax on sugar-sweetened

1.2
beverages.

Implement the Set of Recommendations on the

1.3
Marketing of Foods and Non-alcoholic Beverages
to Children to reduce the exposure of children and
adolescents to, and the power of, the marketing
of unhealthy foods.

Develop nutrient-profiles to identify unhealthy

1.4
foods and beverages.

1.5 Establish cooperation between Member States to

reduce the impact of cross-border marketing of
unhealthy foods and beverages.

1.6 Implement a standardized global nutrient labelling

system.

1.7 Implement interpretive front-of-pack labelling,

supported by public education of both adults and
children for nutrition literacy.

1.8 Require settings such as schools, child-care

settings, children’s sports facilities and events to
create healthy food environments.

1.9 Increase access to healthy foods in disadvantaged

communities.

viii
2 IMPLEMENT COMPREHENSIVE PROGRAMMES
THAT PROMOTE PHYSICAL ACTIVITY AND
REDUCE SEDENTARY BEHAVIOURS IN CHILDREN
AND ADOLESCENTS.

2.1 Provide guidance to children and adolescents,

their parents, caregivers, teachers and health
professionals on healthy body size, physical activity,
sleep behaviours and appropriate use of screen-
based entertainment.

Ensure that adequate facilities are available on

2.2
school premises and in public spaces for physical
activity during recreational time for all children
(including those with disabilities), with the provision
of gender-friendly spaces where appropriate.

3 INTEGRATE AND STRENGTHEN GUIDANCE FOR

NONCOMMUNICABLE DISEASE PREVENTION
WITH CURRENT GUIDANCE FOR PRECONCEPTION
AND ANTENATAL CARE, TO REDUCE THE RISK OF
CHILDHOOD OBESITY.

3.1 Diagnose and manage hyperglycaemia and

gestational hypertension.

Monitor and manage appropriate gestational

3.2
weight gain.

Include an additional focus on appropriate nutrition

3.3
in guidance and advice for both prospective
mothers and fathers before conception and during
pregnancy.

Develop clear guidance and support for the

3.4
promotion of good nutrition, healthy diets and
physical activity, and for avoiding the use of and
exposure to tobacco, alcohol, drugs and other
toxins.

ix
 4 PROVIDE GUIDANCE ON, AND SUPPORT FOR,
HEALTHY DIET, SLEEP AND PHYSICAL ACTIVITY IN
EARLY CHILDHOOD TO ENSURE CHILDREN GROW
APPROPRIATELY AND DEVELOP HEALTHY HABITS.

4.1 Enforce regulatory measures such as The International

Code of Marketing of Breast-milk Substitutes and
subsequent World Health Assembly resolutions.

4.2 Ensure all maternity facilities fully practice the Ten

Steps to Successful Breastfeeding.

4.3 Promote the benefits of breastfeeding for both mother

and child through broad-based education to parents
and the community at large.

4.4 Support mothers to breastfeed, through regulatory

measures such as maternity leave, facilities and time
for breastfeeding in the work place.

Develop regulations on the marketing of

4.5
complementary foods and beverages, in line with
WHO recommendations, to limit the consumption of
foods and beverages high in fat, sugar and salt by
infants and young children.

Provide clear guidance and support to caregivers

4.6
to avoid specific categories of foods (e.g. sugar-
sweetened milks and fruit juices or energy-dense,
nutrient-poor foods) for the prevention of excess
weight gain.

Provide clear guidance and support to caregivers

4.7
to encourage the consumption of a wide variety of
healthy foods.

Provide guidance to caregivers on appropriate

4.8
nutrition, diet and portion size for this age group.

Ensure only healthy foods, beverages and snacks are

4.9
served in formal child care settings or institutions.

Ensure food education and understanding are

4.10
incorporated into the curriculum in formal child-care
settings or institutions.

Ensure physical activity is incorporated into the daily

4.11
routine and curriculum in formal child care settings or
institutions.

4.12 Provide guidance on appropriate sleep time, sedentary

or screen-time, and physical activity or active play for
the 2–5 years of age group.

4.13 Engage whole-of-community support for caregivers

and child care settings to promote healthy lifestyles for
young children.

x
5 IMPLEMENT COMPREHENSIVE PROGRAMMES
THAT PROMOTE HEALTHY SCHOOL
ENVIRONMENTS, HEALTH AND NUTRITION
LITERACY AND PHYSICAL ACTIVITY AMONG
SCHOOL-AGE CHILDREN AND ADOLESCENTS.

5.1 Establish standards for meals provided in schools,

or foods and beverages sold in schools, that meet
healthy nutrition guidelines.

5.2 Eliminate the provision or sale of unhealthy

foods, such as sugar-sweetened beverages and
energy-dense, nutrient-poor foods, in the school
environment.

Ensure access to potable water in schools and sports

5.3
facilities.

5.4 Require inclusion of nutrition and health education

within the core curriculum of schools.

5.5 Improve the nutrition literacy and skills of parents

and caregivers.

5.6 Make food preparation classes available to children,

their parents and caregivers.

5.7 Include Quality Physical Education in the school

curriculum and provide adequate and appropriate
staffing and facilities to support this.

6 PROVIDE FAMILY-BASED, MULTICOMPONENT,

LIFESTYLE WEIGHT MANAGEMENT SERVICES FOR
CHILDREN AND YOUNG PEOPLE WHO ARE OBESE.

6.1 Develop and support appropriate weight

management services for children and adolescents
who are overweight or obese that are family-
based, multicomponent (including nutrition, physical
activity and psychosocial support) and delivered
by multi-professional teams with appropriate
training and resources, as part of Universal Health
Coverage.

xi
ACTIONS AND RESPONSIBILITIES
FOR IMPLEMENTING THE RECOMMENDATIONS

ACTIONS AND RESPONSIBILITIES FOR:

WHO A Institutionalize a cross-cutting and life-course

approach to ending childhood obesity across all
relevant technical areas in WHO headquarters,
regional and country offices.

B Develop, in consultation with Member States, a

framework to implement the recommendations of
the Commission.

C Strengthen capacity to provide technical support for

action to end childhood obesity at global, regional
and national levels.

D Support international agencies, national

governments and relevant stakeholders in building
upon existing commitments to ensure that relevant
actions to end childhood obesity are implemented at
global, regional and national levels.

E Promote collaborative research on ending childhood

obesity with a focus on the life-course approach.

F Report on progress made on ending childhood obesity.

International A Cooperate to build capacity and support Member

organizations States in addressing childhood obesity.

Members A Take ownership, provide leadership and engage

States political commitment to tackle childhood obesity
over the long term.

B Coordinate contributions of all government sectors

and institutions responsible for policies, including,
but not limited to: education; food, agriculture;
commerce and industry; development; finance and
revenue; sport and recreation; communication;
environmental and urban planning; transport and
social affairs; and trade.

C Ensure data collection on BMI-for-age of children

– including for ages not currently monitored – and
set national targets for childhood obesity.

D Develop guidelines, recommendations or policy

measures that appropriately engage relevant
sectors – including the private sector, where
applicable – to implement actions, aimed at
reducing childhood obesity, as set out in this report.

xii
Nongovernmental A Raise the profile of childhood obesity prevention
organizations through advocacy efforts and the dissemination of
information.
B
Motivate consumers to demand that governments
support healthy lifestyles and that the food and
non-alcoholic beverage industry provide healthy
products, and do not market unhealthy foods
and sugar-sweetened beverages to children.

C Contribute to the development and

implementation of a monitoring and
accountability mechanism.

The private sector A Support the production of, and facilitate access to,
foods and non-alcoholic beverages that contribute to a
healthy diet.

B Facilitate access to, and participation in, physical activity.

Philanthropic A Recognize childhood obesity as endangering child

foundations health and educational attainment and address
this important issue.

B Mobilize funds to support research, capacity-

building and service delivery.

Academic institutions A Raise the profile of childhood obesity prevention

through the dissemination of information and
incorporation into appropriate curricula.

B Address knowledge gaps with evidence to

support policy implementation.

C Support monitoring and accountability activities.

The greatest obstacle to effective
progress on reducing childhood
obesity is a lack of political
commitment and a failure of
governments and other actors to
take ownership, leadership and
necessary actions.
Governments must invest in robust
monitoring and accountability
systems to track the prevalence
of childhood obesity. These
systems are vital in providing
data for policy development and
in offering evidence of the impact
and effectiveness of interventions.
The Commission would like
to stress the importance and
necessity of tackling the
complex issue of childhood
obesity. WHO, international
organizations and their Member
States, as well as non-State
actors, all have a critical role to
play in harnessing momentum
and ensuring that all sectors
remain committed to working
together to reach a positive
conclusion.

xiii
xiv
GOALS OF THE
COMMISSION

The overarching goals of the Commission on

Ending Childhood Obesity are to provide policy
recommendations to governments to prevent infants,
children and adolescents from developing obesity,
and to identify and treat pre existing obesity in
children and adolescents.

The aims are to reduce the risk of morbidity and

mortality due to noncommunicable diseases, lessen
the negative psychosocial effects of obesity both in
childhood and adulthood and reduce the risk of the
next generation developing obesity.

1
INTRODUCTION
The obesity epidemic has the
potential to negate many of
the health benefits that have
contributed to the increased
longevity observed in the world.
In 2014, an estimated 41 million
children under 5 years of age
were affected by overweight
or obesity (1) (defined as the
proportion of children with
weight-for-height z-score values
more than 2 SDs and more
than 3 SDs, respectively, from
the WHO growth standard
median (2)). Figure 1 shows
the prevalence of overweight
children under 5 years of age
worldwide. In Africa, the number
of children who are overweight
or obese has nearly doubled
since 1990, increasing from
5.4 million to 10.3 million. In
2014, of children under 5 years
of age who were overweight,
48% lived in Asia and 25% in
Africa (1). The prevalence of
infant, childhood and adolescent
obesity may be plateauing in
some settings, but in absolute
numbers more overweight and
obese children live in low- and
2
middle-income countries than
in high-income countries (3).
Figure 2 shows the prevalence
of overweight by WHO region
and World Bank income group.
Prevalence data available for
older children and adolescents
are currently being verified and
are due to be released by WHO
in 2016. To date, progress in
tackling childhood obesity has
been slow and inconsistent (4).
An even greater number of
children are, even from before
birth, on the pathway to
developing obesity. Children
who are not yet at the body-
mass-index (BMI)-for-age
threshold for the current
definition of childhood obesity
or overweight may be at an
increased risk of developing
obesity. The recommendations
in this report also address
the needs of these children.
Undernutrition in early childhood
places children at an especially
high risk of developing obesity
when food and physical activity
patterns change.
Many countries now face the
burden of malnutrition in all its
forms, with rising rates of childhood
obesity as well as high rates of
child undernutrition and stunting.
Childhood obesity is often under-
recognized as a public health issue
in these settings, where, culturally,
an overweight child is often
considered to be healthy.
In high-income countries, the risks
of childhood obesity are greatest
in lower socioeconomic groups.
Although currently the converse
is true in most low- and middle-
income countries, a changing
pattern is emerging. Within
countries, certain population
subgroups, such as migrant
and indigenous children, are
at a particularly high risk of
becoming obese (5), due to rapid
acculturation and poor access
to public health information.
As countries undergo rapid
socioeconomic and/or nutrition
transitions, they face a double
burden in which inadequate
nutrition and excess weight gain
co-exist (6).
 FIGURE1:
AGE-STANDARDIZED PREVALENCE OF OVERWEIGHT IN CHILDREN UNDER 5 YEARS OF AGE,
COMPARABLE ESTIMATES, 2014

Latest Prevalence
(0) No data
(1) < 5.0%
(2) 5.0 - 9.9%
(3) 10.0 - 14.9%
(4) 15.0 - 19.9%
(5) ≥ 20%

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization
concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent
approximate border lines for which there may not yet be full agreement. All rights reserved. Copyright – WHO 2015.

Source: Tracking tool (http://www.who.int/nutrition/trackingtool)

FIGURE2:
PREVALENCE OF OVERWEIGHT IN CHILDREN UNDER 5 YEARS OF AGE, BY WHO REGION AND
WORLD BANK INCOME GROUP, COMPARABLE ESTIMATES, 2014

14

12

10
Overweight (%)

0
AFR AMR EMR EUR SEAR WPR High Upper Lower Low
income middle middle income
income income

AFR=African Region, AMR=Region of Americas, SEAR=South-East Asia Region, EUR=European Region, EMR=Eastern Mediterranean Region, WPR=Western Pacific Region.

Source: UNICEF, WHO, The World Bank. Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2015).

3
Obesity arises from a
combination of exposure of the
child to an unhealthy environment
(often called the obesogenic
environment (7)) and inadequate
behavioural and biological
responses to that environment.
These responses vary among
individuals and are strongly
influenced by developmental or
life-course factors.
Many children today are
growing up in environments
that encourage weight gain
and obesity. With globalization
and urbanization, exposure to
the obesogenic environment is
increasing in both high-income
countries and low- and middle-
income countries and across all
socioeconomic groups. Changes
in food availability and type, and
10.3 MILLION
In Africa, the number of children
who are overweight or obese
has nearly doubled since 1990,
increasing from 5.4 million to
10.3 million.
4
a decline in physical activity for
transport or play, have resulted
in energy imbalance. Children
are exposed to ultra-processed,
energy-dense, nutrient-poor
foods, which are cheap and
readily available. Opportunities
for physical activity, both in and
out of school, have been reduced
and more time is spent on screen-
based and sedentary leisure
activities.
Cultural values and norms
influence the perception of
healthy or desirable body weight,
especially for infants, young
children and women. In some
settings, overweight and obesity
are becoming social norms
and thus contributing to the
perpetuation of the obesogenic
environment.
5
The risk of obesity can be passed
from one generation to the next,
as a result of behavioural and/
or biological factors. Behavioural
influences continue through
generations as children inherit
socioeconomic status, cultural
norms and behaviours, and
family eating and physical activity
behaviours.
Biological factors can lead to
an increase in the risk of obesity
in children through two general
developmental pathways:
(i) The “mismatch” pathway.
This results from malnutrition
– sometimes subtle – during
fetal and early childhood
development, due, for example,
to poor maternal nutrition or
In absolute
numbers more
overweight and
obese children
live in low- and
middle-income
countries than
in high-income
countries.
6
placental insufficiency. The
underlying processes involve
environmental effects on gene
function (epigenetic effects) that
do not necessarily have obvious
effects on measures such as birth
weight (8). Children who have
suffered from undernutrition and
were born with low birth weight
or are short-for-age (stunted), are
at far greater risk of developing
overweight and obesity when
faced with energy-dense diets
and a sedentary lifestyle later
in life. Attempts to deal with
undernutrition and stunting during
childhood may have led to the
unintended consequences of
obesity risk for these children.
(ii) The developmental pathway.
This is characterized by the
mother entering pregnancy with
obesity or pre-existing diabetes,
or developing gestational
diabetes. This predisposes the
child to increased fat deposits
associated with metabolic disease
and obesity. This pathway
may also involve epigenetic
processes. Recent research
indicates that paternal obesity
can also contribute to a greater
risk of obesity in the child (9),
probably through epigenetic
mechanisms. Inappropriate early
infant feeding also impacts on
the child’s developing biology.
Appropriate interventions before
conception, during pregnancy
and in infancy may prevent some
of these effects, but these may
not easily be reversed once a
critical period of development
has passed. Since many women
do not consult a healthcare
professional until the end of
the first trimester, it is essential
to promote knowledge of the
importance of healthy behaviours
in adolescents, young women and
men before conception and in
early pregnancy.
Overweight and obesity are
not absolute cut-offs and many
children are on the pathway to
obesity when they are within
the normal range for BMI-for-
age. The health consequences
of overweight and obesity are
also continuous and can affect
a child’s quality of life before
BMI-for-age cut-offs are reached.
Across the distribution of BMI
there is a trend for individuals
to have more body fat and
less lean muscle mass than in
previous generations (10). The
pattern of fat deposit in the
body is also important in terms
of health outcomes (11). Some
population groups have more
fat deposits and less lean muscle
mass than others at the same
BMI. Although BMI is the simplest
means to identify children who
are overweight and obese, it
does not necessarily identify
children with abdominal fat
deposits that put them at greater
risk of health complications.
While new methodologies are
available, such as dual-energy
X-ray absorptiometry, magnetic
resonance imaging or body
impedance to measure body fat
and lean mass, these are currently
beyond the scope of population-
based surveys.
None of these upstream causal
factors are in the control of
the child. Therefore, childhood
obesity should not be seen as a
result of voluntary lifestyle choices,
particularly by the younger child.
Given that childhood obesity
is influenced by biological and
contextual factors, governments
must address these issues by
providing public health guidance,
education and establishing of noncommunicable diseases
regulatory frameworks to address impair the individual’s lifetime
developmental and environmental educational attainment and labour
risks, in order to support families’ market outcomes and place a
efforts to change behaviours. significant burden on health-care
Parents, families, caregivers and systems, family, employers and
educators also play a critical society as a whole (20).
role in encouraging healthy
behaviours. Prevention of childhood obesity
will result in significant economic
Obesity has physical and intergenerational benefits that
and psychological health currently cannot be accurately
consequences during childhood, estimated or quantified. Spill-over
adolescence and into adulthood. benefits also include improved
Obesity itself is a direct cause maternal and reproductive health
of morbidities in childhood and a reduction in obesogenic
including gastrointestinal, exposure for all members of
musculoskeletal and orthopaedic the population, thus further
complications, sleep apnoea, strengthening the case for urgent
and the accelerated onset of action.
cardiovascular disease and
type-2 diabetes, as well as the
comorbidities of the latter two
noncommunicable diseases
(12). Obesity in childhood
can contribute to behavioural
and emotional difficulties, such
as depression, and can also
lead to stigmatization and
poor socialization and reduce
educational attainment (13, 14).
Critically, childhood obesity is a
strong predictor of adult obesity,
which has well known health and
economic consequences, both
for the individual and society
as a whole (15, 16). Although
longitudinal studies suggest that
improving BMI in adulthood can
reduce the risk of morbidity and
mortality (17), childhood obesity
will leave a permanent imprint on
adult health (18).
Childhood obesity
Evidence on the lifetime cost of is a strong
childhood obesity is developing,
but is scarce compared with predictor of adult
that on the economic burden of obesity, which has
adult obesity. To date, studies
have concentrated primarily on well known health
healthcare expenditure, ignoring and economic
other costs, including the cost of
the accelerated onset of adult consequences,
diseases and the tendency for both for the
childhood obesity to continue
into adulthood with attendant
individual and
economic costs (19). Early onset society as a whole.
7
GUIDING
PRINCIPLES

THE COMMISSION The child’s right to health: A whole-of-government

AFFIRMS THE Government and society have approach: Obesity prevention
a moral responsibility to act on and treatment requires a whole-
FOLLOWING behalf of the child to reduce the of-government approach in
PRINCIPLES AND risk of obesity. Tackling childhood which policies across all sectors
STRATEGIES: obesity resonates with the systematically take health
universal acceptance of the rights into account, avoid harmful
of the child to a healthy life as health impacts and so improve
well as the obligations assumed population health and health
by State Parties to the Convention equity. The education sector
of the Rights of the Child.1 plays a critical role in providing
nutrition and health education,
Government commitment increasing the opportunities for
and leadership: Rates of physical activity and promoting
childhood obesity are reaching healthy school environments.
alarming proportions in many Agriculture and trade policies
countries, posing an urgent and the globalization of the
and serious challenge. These food system impact on food
increasing rates cannot be affordability, availability and
ignored and governments need quality at national and local
to accept primary responsibility levels. In 2006, WHO Member
in addressing this issue on behalf States adopted a resolution to
of the children they are ethically consider the interplay between
bound to protect. A failure to act international trade and health
will have major medical, social through multistakeholder
and economic consequences. dialogue.2 Urban planning

1
Committee on the Rights of the Child: General comment No. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (art. 24), para 47;
CRC/C/GC/15.
2
Resolution WHA59.26 on international trade and health.

8
9
and design, and transport
planning, all impact directly
on opportunities for physical
activity and access to healthy
foods. Intersectoral government
structures can facilitate
coordination, identify mutual
interest, collaboration and
exchange of information through
coordinating mechanisms.
A whole-of-society
approach: The complexity of
obesity calls for a comprehensive
approach involving all actors,
including governments, parents,
caregivers, civil society,
academic institutions and the
private sector. Moving from
policy to action to address
childhood obesity demands
a concerted effort and an
10
engagement of all sectors of
society at the national, regional
and global levels. Without
joint ownership and shared
responsibility, well-meaning and
cost-effective interventions have
limited reach and impact.
Equity: Governments should
ensure equitable coverage of
interventions, particularly for
excluded, marginalized or
otherwise vulnerable population
groups, who are at high risk both
of malnutrition in all its forms
and of developing obesity. These
population groups often have
poor access to healthy foods, safe
places for physical activity and
preventative health services and
support. Obesity and its associated
morbidities erode the potential
improvements in social and health
capital, and increase inequity.
Aligning with the global
development agenda:
The Sustainable Development
Goals (SDG) call for an end to
malnutrition in all its forms (SDG
target 2.2) and a reduction
in premature mortality from
noncommunicable diseases (SDG
target 3.4). Childhood obesity
undermines the physical, social
and psychological well-being
of children and is a known risk
factor for adult obesity and
noncommunicable diseases.
Progress will be made in achieving
these goals by tackling this issue.
Accountability: Political and
financial commitment is imperative
in combatting childhood
obesity. A robust mechanism
and framework is needed to
monitor policy development and
implementation, thus facilitating
the accountability of governments,
civil society and the private sector
on commitments made.
Integration into a life-
course approach: Integrating
interventions to address childhood
obesity with existing WHO and
other initiatives, using a life-course
approach, will offer additional
benefits for longer-term health.
These initiatives include the United
Nations Secretary General’s
Global Strategy for Women’s,
Children’s and Adolescent’s
Health,1 the Every Woman, Every
Child initiative,2 the Political
Declaration of the High-level fundamental right to health, while
Meeting of the General Assembly reducing the burden on the health
on the Prevention and Control of system.
Non-communicable diseases,3
and the Rome Declaration of the Universal Health Coverage6
Second International Conference and treatment of obesity:
on Nutrition.4 There are a number Sustainable Development Goal
of current WHO and other United target 3.8 calls for the achievement
Nations agencies strategies and of Universal Health Coverage
implementation plans related to through integrated health services
optimizing maternal, infant and that enable people to receive a
child nutrition and adolescent continuum of health promotion,
health that are highly relevant to disease prevention, diagnosis,
key elements of a comprehensive treatment and management,
approach to obesity prevention. over the course of a lifetime.7 As
Relevant principles and such, prevention of overweight
recommendations can be found and obesity and the treatment of
in documents providing guidance children already obese, and those
throughout the life-course.5 with overweight who are on the
Initiatives to address childhood pathway to obesity, should be
obesity should build upon these considered an element of Universal
to help children realize their Health Coverage.
Without joint ownership and shared
responsibility, well-meaning and cost-
effective interventions have limited
reach and impact.
1
http://www.who.int/life-course/partners/global-strategy/global-strategy-2016-2030/en/.
2
http://www.everywomaneverychild.org.
3
http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf.
4
http://www.fao.org/3/a-ml542e.pdf.
5
WHA Resolutions: WHA53.17 on Prevention and Control of Noncommunicable Diseases; WHA57.17 on the Global
Strategy on Diet, Physical Activity and Health; WHA61.14 on Prevention and Control of Noncommunicable Diseases:
Implementation of the Global Strategy; WHA63.14 on Marketing of Food and Non-alcoholic Beverages to Children;
WHA65.6 on the Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition; and WHA66.10
on the follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and
Control of Non-communicable diseases; WHA68.19 Outcome of the Second International Conference on Nutrition.
Meeting to Develop a Global Consensus on Preconception Care to Reduce Maternal and Childhood Mortality and
Morbidity, WHO, 2013; The optimal duration of exclusive breastfeeding. Report of an expert consultation, WHO,
2001; Complementary feeding. Report of global consultation: summary of guiding principles, WHO, 2002; Global
recommendations on physical activity for health, WHO, 2012; Population-based approaches to childhood obesity
prevention, WHO, 2010; PAHO/AMRO Plan of Action for the Prevention of Obesity in Children and Adolescents, 53rd
Directing Council, 66th Session of the Regional Committee of WHO for the Americas, October 2014; Resolution EUR/
RC63/R4 Vienna Declaration on Nutrition and Noncommunicable Diseases in the Context of Health 2020; WPR/RC63.
R2 Scaling up Nutrition in the Western Pacific Region.
6
http://www.who.int/universal_health_coverage/en/.
7
United Nations General Assembly Resolution A/67/L36 Global Health and Foreign Policy.
11
STRATEGIC
OBJECTIVES
No single intervention can halt the rise of the
growing obesity epidemic. To successfully
challenge childhood obesity requires
addressing the obesogenic environment as
well as critical elements in the life-course.

TACKLE THE
OBESOGENIC
ENVIRONMENT
AND NORMS
1 2

The major goals of addressing
the environmental components
include improving healthy eating
and physical activity behaviours
of children. A number of factors
influence the obesogenic
environment, including political
and commercial factors (trade
agreements, fiscal and agricultural
policies and food systems); the
built environment (availability of
healthy foods, infrastructure and
opportunities for physical activity
in the neighbourhood); social
norms (body weight and image
norms, cultural norms regarding
the feeding of children and the
status associated with higher body
mass in some population groups,
social restrictions on physical
activity) and family environment
(parental nutrition knowledge and
behaviours, family economics,
family eating behaviours).

12
REDUCE THE RISK OF
OBESITY BY ADDRESSING
CRITICAL ELEMENTS
IN THE LIFE-COURSE
3 4 5

Developmental factors change both the biology and behaviour of individuals from
before birth and through infancy, such that they develop with a greater or lesser
risk of developing obesity. The Commission considers it essential to address both the
environmental context and three critical time periods in the life-course: preconception and
pregnancy, infancy and early childhood and older childhood and adolescence.

It is the primary responsibility
of governments to ensure that
policies and actions address
the obesogenic environment
and to provide guidance and
support for optimal development
at each stage of the life-course.
By focusing attention on these
sensitive periods of the life-course,
interventions can address specific
risk factors, both individually
and in combination. Such an
approach can be integrated into
other components of the maternal-
neonatal-child health agenda,
and to the broader effort to tackle
noncommunicable diseases across
the whole population.

13
TREAT CHILDREN
WHO ARE OBESE
TO IMPROVE THEIR
CURRENT AND
FUTURE HEALTH
6
When children are already
overweight or obese, additional
goals include reduction in
the level of overweight,
improvement in obesity-related
comorbidities and improvement
in risk factors for excess weight
gain. The health sector in each
country varies considerably and
ROLES AND
RESPONSIBILITIES
The Commission recognizes that
the scope of potential policy
recommendations to address
childhood obesity is broad and
contains a number of novel
elements, including a focus on the
life-course dimension and on the
education sector. A multisectoral
approach will be essential for
sustained progress.
Countries should measure BMI-for-
age to establish the prevalence
and trends in childhood obesity
at national, regional and
14
will face different challenges
in responding to the need for
treatment services for those
with obesity. However, the
management of children with
overweight and obesity should
be included in effective services
extended under Universal Health
Coverage.
local levels. They should also
gather data on nutrition, eating
behaviours and physical activity
of children and adolescents
across different socioeconomic
groups and settings. Although
some data are collected (21),
there remains a significant gap
for children over 5 years of age
that needs addressing. This data
will guide the development of
appropriate policy priorities and
provide a baseline against which
to measure the success of policies
and programmes.
15
RECOMMENDATIONS
The recommendations and accompanying rationales,
presented below, were developed by the Commission
following the review of the scientific evidence, the
reports of the ad hoc working groups to the WHO
Director-General, and feedback from the regional
and online consultations. The effectiveness, cost-
effectiveness, affordability and applicability of
policies and interventions were also considered.

16
 IMPLEMENT COMPREHENSIVE PROGRAMMES
1 THAT PROMOTE THE INTAKE OF HEALTHY FOODS
AND REDUCE THE INTAKE OF UNHEALTHY
FOODS AND SUGAR-SWEETENED BEVERAGES BY
CHILDREN AND ADOLESCENTS.

Nutrition information can be of trade reform can affect diet

confusing and thus poorly
understood by many people.
Given that individuals and
families choose their diets,
the population needs to be
empowered to make healthier
choices about what to eat
and provide their infants and
children. This is not possible
unless nutrition literacy is
universal and provided in
a manner that is useful,
understandable and accessible
to all members of society.
Recent trends in food
production, processing, trade,
marketing and retailing have
contributed to the rise in diet-
related noncommunicable
diseases. The potential impact
and nutrition transition. The
health and equity impacts of
national and international
economic agreements and
policies need to be considered
(22). Processed, energy-
dense, nutrient-poor foods and
sugar-sweetened beverages,
in increasing portion size,
at affordable prices have
replaced minimally-processed
fresh foods and water in many
settings at school and family
meals. The easy access to
energy-dense foods and sugar-
sweetened beverages and
the tacit encouragement to
“size-up” through commercial
promotions have contributed to
the rising caloric intake in many
populations.

RECOMMENDATIONS RATIONALE

It is not sufficient to rely on nutrient labelling or simple codes such as

1.1
traffic light labels or health star ratings. All governments must lead in
Ensure that appropriate developing and disseminating appropriate and context-specific food-
and context specific based dietary guidelines for both adults and children. The necessary
nutrition information and information should be provided through media and educational outlets
guidelines for both adults and public health messaging in ways that reach all segments of the
and children are developed population, such that all of society is empowered to make healthier
and disseminated in a choices.
simple, understandable and
accessible manner to all As children enter school, health and nutrition literacy should be
groups in society. included in the core curriculum and supported by a health-promoting
school environment (see recommendations for early childhood, school-
age children and adolescents).

17
RECOMMENDATIONS RATIONALE

1.2 The adoption of fiscal measures for obesity prevention has received
a great deal of attention (23) and is being implemented in a
Implement an effective number of countries.1 Overall, the rationale for taxation measures
tax on sugar-sweetened to influence purchasing behaviours is strong and supported by the
beverages. available evidence (24, 25). Further evidence will become available
as countries that implement taxes on unhealthy foods and/or sugar-
sweetened beverages monitor their progress.2 The Commission
believes there is sufficient rationale to warrant the introduction of an
effective tax on sugar-sweetened beverages.

It is well established that the consumption of sugar-sweetened

beverages is associated with an increased risk of obesity (26, 27).
Consumption patterns may vary in different settings (28) and more
detail is needed about the patterns of intake in children in different
settings. Low-income consumers and their children have the greatest
risk of obesity in many societies and are most influenced by price.
Fiscal policies may encourage this group of consumers to make
healthier choices (provided healthier alternatives are made available)
as well as providing an indirect educational and public health signal
to the whole population.

Available evidence indicates that taxes on products such as sugar-

sweetened beverages are the most feasible to implement with data
indicating an impact on consumption.

Some countries may consider taxes on other unhealthy foods, such as

those high in fats and sugar. Taxing energy-dense, nutrient-poor foods
would require the development of nutrient profiles (29) and modelling
suggests this may reduce consumption.

1.3 There is unequivocal evidence that the marketing of unhealthy foods

and sugar-sweetened beverages is related to childhood obesity (30,
Implement the Set of 31). Despite the increasing number of voluntary efforts by industry,
Recommendations on the exposure to the marketing of unhealthy foods remains a major issue
Marketing of Foods and demanding change that will protect all children equally. Any attempt
Non-alcoholic Beverages to tackle childhood obesity should, therefore, include a reduction in
to Children to reduce the exposure of children to, and the power of, marketing.
exposure of children and
adolescents to, and the Settings where children and adolescents gather (such as schools and
power of, the marketing of sports facilities or events) and the screen-based offerings they watch
unhealthy foods. or participate in, should be free of marketing of unhealthy foods and
sugar-sweetened beverages. The Commission notes with concern the
failure of Member States to give significant attention to Resolution
WHA 63.14 endorsed by the World Health Assembly in 20103
and requests that they address this issue. Parents and caregivers are
increasingly the target of marketing for foods and beverages high in
fats and sugar, aimed at their children (32).

1
http://www.wcrf.org/int/policy/nourishing-framework/use-economic-tools.
2
See preliminary data on Mexico tax on sugar-sweetened beverages which has been submitted for publication (http://www.insp.mx/epppo/blog/3666-reduccion-consumo-bebidas.html).
3
WHA63.14 on the Marketing of Food and Non-alcoholic Beverages to Children.

18
RECOMMENDATIONS RATIONALE

1.4 There is wide variation in the types of business, attitudes and

behaviour within the food and non-alcoholic beverage, retail
Develop nutrient-profiles to and marketing industries. Even voluntary initiatives must conform
identify unhealthy foods and to guidelines determined by government and must be subject to
beverages. independent audit. Governments must define clear parameters,
enforcement and monitoring mechanisms and, if necessary, consider
regulatory and statutory approaches. Regulation would provide equal
1.5 protection to all children regardless of socioeconomic group and
ensure equal responsibility by large, regional, multinational and small
Establish cooperation
local producers and retailers.
between Member States
to reduce the impact of
Clarity on the range of healthy products that can be marketed without
cross-border marketing
restriction is needed, as is consideration of both direct and indirect
of unhealthy foods and
marketing strategies, including pricing, promotion (including portion-
beverages.
size promotion) and placement. Such approaches require identifying
healthy and unhealthy foods using independent nutrient profiling.
These considerations must also take into account issues of food
security, where this is relevant, either at a national, sub-national or
sub-population level.

The WHO Framework for implementing the set of recommendations

on the marketing of foods and non-alcoholic beverages to children
(33) provides practical guidance to Member States on the
development and implementation of policy and monitoring and
evaluation frameworks.

The Commission recognizes that in certain settings adolescents

consume alcohol, and that alcohol is particularly obesogenic.
Although this is beyond their scope of work, the Commission notes
that it is very difficult to market alcoholic products targeted at young
adult consumers, in particular, without exposing cohorts of adolescents
under the legal age to the same marketing. The exposure of children
and young people to appealing marketing is of particular concern.
A precautionary approach to protecting young people against the
marketing of such products is needed.

1.6 A standardized system of food labelling, as recommended by the

Codex Alimentarius Commission1 can support nutrition and health
Implement a standardized literacy education efforts, if mandatory for all packaged foods and
global nutrient labelling beverages.
system.

1
WHA56.23 Joint FAO/WHO evaluation of the work of the Codex Alimentarius Commission.

19
RECOMMENDATIONS
1.7
Implement interpretive front-
of-pack labelling supported
by public education of both
adults and children for
nutrition literacy.
1.8
Require settings such as
schools, child-care settings,
children’s sports facilities and
events to create healthy food
environments.
1.9
Increase access to healthy
foods in disadvantaged
communities.
20
RATIONALE
Healthy eating habits can be nurtured from infancy and have both
biological and behavioural dimensions. This requires caregiver
understanding of the relationship between diet and health, and
behaviours to encourage and support the development of such healthy
habits. Simple, easy to understand food labelling systems can support
nutrition education and help caregivers and children to make healthier
choices.
Nutrition and food literacy and knowledge will be undermined if
there are conflicting messages in the settings where children gather.
Schools, child-care and sports facilities should support efforts to
improve children’s nutrition by making the healthy choice the easy
choice and not providing or selling unhealthy foods and beverages.
Nutrition literacy and knowledge of healthy food choices also cannot
be acted upon if such foods are not readily available or affordable.
Influencing the food environment requires a collaborative approach
to food production, processing, accessibility, availability and
affordability. Where access to healthy foods is limited, ultra-processed
foods are often the only available and affordable alternatives. A
number of public and private sector initiatives to promote healthier
food behaviours have been developed and the limited evidence
available indicates the potential to promote healthier choices among
consumers (34). Such initiatives, where they are supported by
evidence, are to be encouraged.
 IMPLEMENT COMPREHENSIVE PROGRAMMES
2 THAT PROMOTE PHYSICAL ACTIVITY AND REDUCE
SEDENTARY BEHAVIOURS IN CHILDREN AND
ADOLESCENTS.
Recent evidence shows that
physical activity declines from
the age of school entry (35).
Globally, in 2010, 81% of
adolescents aged 11–17 years
were insufficiently physically
active. Adolescent girls were
less active than adolescent
boys, with 84% of girls and
78%1 of boys not attaining
the 60 minutes of moderate to
vigorous physical activity daily
as recommended by WHO
(36). Low physical activity is
rapidly becoming the social
norm in most countries, and
is an important factor in the
obesity epidemic. Physical
activity can reduce the risk
of diabetes, cardiovascular
disease and cancers (37), and
improve children’s ability to
learn, their mental health and
well-being. Recent evidence
suggests that obesity, in turn,
reduces physical activity,
creating a vicious cycle of
increasing body fat levels and
declining physical activity.
81%
of adolescents do not achieve
the recommended 60 minutes
of physical activity each day.
1
http://apps.who.int/gho/data/view.main.2482ADO?lang=en.
Urban planning and design has
the potential to both contribute
to the problem and offer the
opportunity to form part of the
solution. Increased recreational
space and safe walking-
and cycling-paths for active
transport, help make physical
activity functions of daily life.
Physical activity behaviours
across the life-course can be
heavily influenced by childhood
experience. Creating safe,
physical activity-friendly
communities, which enable,
and encourage the use of active
transport (walking, cycling etc.)
and participation in an active
lifestyle and physical activities,
will benefit all communities.
Particular attention needs to
be given to improving access
to, and participation in,
physical activity for children
already affected by overweight
and obesity, disadvantaged
children, girls and children with
disabilities.
21
RECOMMENDATIONS
2.1
Provide guidance to
children and adolescents,
their parents, caregivers,
teachers and health
professionals on healthy
body size, physical activity,
sleep behaviours and
appropriate use of screen-
based entertainment.
2.2
Ensure that adequate
facilities are available
on school premises and
in public spaces for
physical activity during
recreational time for all
children (including those
with disabilities), with the
provision of gender-friendly
spaces where appropriate.
Physical activity can reduce
the risk of diabetes,
cardiovascular disease and
cancers, and improve children’s
ability to learn, their mental
health and well-being.
22
RATIONALE
All members of society, including parents, need to appreciate the
importance of both adequate growth and the consequences of
excess body fat deposition to the short-term and long-term health
and well-being of the child. The Commission recognizes that in
some cultures this may be in conflict with traditional perceptions and
practice.
Physical activity provides fundamental health benefits for children
and adolescents, including increased cardiorespiratory and muscular
fitness, reduced body fatness and enhanced bone health.
Context-specific guidance on how to achieve physical activity
recommendations and the appropriate number of hours that
children should sleep or watch television (38–40), for example,
should be a component of any healthy-living education provided to
children or caregivers.
Increasing the opportunities for safe, appropriate and gender-
friendly structured and unstructured physical activity, both in and
out of school, including active transport (walking and cycling), will
have positive health, behavioural and educational spill-over effects
for all children and adolescents.
23
 INTEGRATE AND STRENGTHEN GUIDANCE FOR
3 NONCOMMUNICABLE DISEASE PREVENTION
WITH CURRENT GUIDANCE FOR PRECONCEPTION
AND ANTENATAL CARE, TO REDUCE THE RISK OF
CHILDHOOD OBESITY.

The care that women receive to include advice to would-be

before, during and after fathers.
pregnancy has profound
implications for the later health Current guidance for
and development of their preconception and antenatal
children. Timely and good-quality care focuses on the prevention
care throughout these periods of fetal undernutrition. Given
provides important opportunities changing obesogenic exposures,
to prevent the intergenerational guidelines are needed that
transmission of risk and has a address malnutrition in all
high impact on the health of its forms (including caloric
the child throughout the life- excess) and later obesity risk in
course.1 Evidence shows that the offspring. Interventions to
maternal undernutrition (whether address childhood obesity risk
global or nutrient-specific), factors also prevent other adverse
maternal overweight or obesity, pregnancy outcomes (47) and so
excess pregnancy weight gain, contribute to improving maternal
maternal hyperglycaemia and newborn health. Maternal
(including gestational diabetes), overweight and obesity increase
smoking or exposure to toxins the risk of complications during
can increase the likelihood pregnancy, labour and delivery
of obesity during infancy and (including stillbirth), and maternal
childhood (41–46). Evidence undernutrition increases the risk
is emerging that the health of of low birth weight. These factors
fathers at the time of conception can put the child at greater risk of
can influence the risk of obesity infant mortality, childhood obesity
in their children (9). Healthy and adult noncommunicable
lifestyle guidance thus needs diseases.

The care that a woman

receives before, during and
after pregnancy has profound
implications for the later health
and development of her child.

1
Committee on the Rights of the Child: General comment No. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (art. 24), para 53;
CRC/C/GC/15.

24
RECOMMENDATIONS
3.1
Diagnose and manage
hyperglycaemia and
gestational hypertension.
3.2
Monitor and manage
appropriate gestational
weight gain.
3.3
Include an additional focus
on appropriate nutrition
in guidance and advice
for both prospective
mothers and fathers before
conception and during
pregnancy.
3.4
Develop clear guidance and
support for the promotion of
good nutrition, healthy diets
and physical activity, and
for avoiding the use of and
exposure to tobacco, alcohol,
drugs and other toxins.
RATIONALE
There is a need for screening and appropriate management of pre-
existing diabetes mellitus and hypertension in pregnant women; early
diagnosis and effective management of gestational diabetes and
pregnancy-induced hypertension, depression and mental health issues;
gestational weight gain pattern (48); and ensuring dietary quality and
appropriate physical activity.
Interventions that integrate guidance related to all forms of malnutrition
should address undernutrition and unbalanced diets, including excess
nutrition and specific nutrition deficiencies (49). Young people are
often unaware of what constitutes a healthy diet. This highlights the
need for governments to take leadership in ensuring nutrition and food
literacy.
There is evidence for the beneficial effects of appropriate exercise
programmes in pregnancy on maternal BMI, gestational weight gain
and birth outcomes, which are linked to a later risk of childhood
obesity (50).
There is limited, but growing, evidence that paternal health prior to
conception has some impact on offspring health (9). There are, thus,
direct reasons to also target paternal behaviour and health.
25
 PROVIDE GUIDANCE ON AND SUPPORT FOR
4 HEALTHY DIET, SLEEP AND PHYSICAL ACTIVITY IN
EARLY CHILDHOOD TO ENSURE CHILDREN GROW
APPROPRIATELY AND DEVELOP HEALTHY HABITS.

The first years of life are critical
in establishing good nutrition
and physical activity behaviours
that reduce the risk of developing
obesity. Exclusive breastfeeding
for the first six months of life,
followed by the introduction of
appropriate complementary foods,
is a significant factor in reducing
the risk of obesity (51). Appropriate
complementary feeding with
continued breastfeeding can reduce
the risk of undernutrition and excess
body fat deposition in infants, both
risk factors for childhood obesity.
Encouraging the intake of a variety
of healthy foods, rather than
unhealthy, energy-dense, nutrient-
poor foods and sugar-sweetened
beverages, during this critical
period supports optimal growth and
development. Health-care providers
can use routine growth monitoring
opportunities to track children’s
BMI-for-age and give appropriate
advice to caregivers to help prevent
children developing overweight
and obesity.

26
RECOMMENDATIONS RATIONALE

Breastfeeding is core to optimizing infant development, growth and

4.1
nutrition and may also be beneficial for postnatal weight management
Enforce regulatory in women.
measures such as The
International Code of Given the changes in women’s lifestyles and roles, the ability to
Marketing of Breast- breastfeed outside of the home, and to sustain breastfeeding when a
milk Substitutes1 and mother returns to work, are critical to achieving the recommendations.
subsequent World Health
Assembly resolutions.2 Policies that establish the rights of women and the responsibilities of
employers are needed and some are in place. However, to protect
all mothers and infants, regardless of social or economic status, these
4.2 should be universal.
Ensure all maternity
facilities fully practice the
Ten Steps to Successful
Breastfeeding.3

4.3

Promote the benefits of

breastfeeding for mother
and child through broad-
based education to parents
and the community at
large.

4.4

Support mothers to
breastfeed, through
regulatory measures
such as maternity leave,
facilities and time for
breastfeeding in the work
place.4

1
WHA34.22 International Code of Marketing of Breast-milk Substitutes.
2
WHA35.26, WHA37.30, WHA39.28, WHA41.11, WHA43.3, WHA45.34, WHA47.5, WHA49.15, WHA54.2, WHA55.25, WHA58.32, WHA59.21, WHA61.20 and WHA63.23 on
Infant and Young Child Nutrition; WHA65.6 Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition.
3
WHO UNICEF Baby-Friendly Hospital Initiative, 1991, updated 2009 (http://www.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse/en/).
4
International Labour Organization, Maternity Protection Convention 183, 2000.

27
RECOMMENDATIONS
4.5
Develop regulations on the
marketing of complementary
foods and beverages, in line
with WHO recommendations,
to limit the consumption of
foods and beverages high in
fat, sugar and salt by infants
and young children.
4.6
Provide clear guidance and
support to caregivers to
avoid specific categories
of foods (e.g. sugar-
sweetened milks and fruit
juices or energy-dense,
nutrient-poor foods) for
the prevention of excess
weight gain.
4.7
Provide clear guidance and
support to caregivers to
encourage the consumption
of a wide variety of healthy
foods.
Breastfeeding is core to
optimizing infant development,
growth and nutrition.
28
RATIONALE
Established global guidance for infant and young child feeding
primarily targets undernutrition. It is also important to consider the
risks created by unhealthy diets in infancy and childhood.
Guidelines that address both undernutrition and obesity risk are
clearly needed for countries where there is malnutrition in all its
forms (32).
Current complementary feeding guidelines (52) provide guidance
on the timing of introduction, responsive feeding, quantity and
types of foods needed.
Family attitudes to eating and perceptions of ideal body weight are
important determinants of complementary feeding behaviours and
need to be considered.
Recent evidence shows that sensory experiences related to food
begin in utero and continue during breastfeeding, and that the
flavours of foods mothers eat are transmitted to their infants. This
and appropriate complementary feeding can play an important
role in establishing food preferences and appetite control.
Encouraging healthy food variety in children through repeated,
positive exposure to new foods (53), seeing caregivers and family
members enjoy healthy foods, and limiting their exposure to
unhealthy foods (that may lead to preferences for very sweet foods
and drinks), all help develop good food habits in children and their
families (54).
RECOMMENDATIONS RATIONALE

4.8
Provide guidance to
caregivers on appropriate
nutrition, diet and portion
size for this age group.
4.9
Ensure only healthy foods,
beverages and snacks are
served in formal child-care
settings or institutions.
4.10
Ensure food education
and understanding are
incorporated into the
curriculum in formal
child-care settings or
institutions.
There is evidence that poor sleeping patterns, low physical activity
and an excess number of hours spent on screen-based entertainment
are associated with increased risk of obesity in childhood (38–40).
The evidence to support early interventions to prevent obesity in high-
income countries is still emerging, but looks very promising. Evidence
supports interventions in pre-school and child-care settings for children
aged 2–5 years for early child feeding, activity patterns, media
exposures and sleep that help to promote healthy behaviours and
weight trajectories in this period of life (55).
Several strategies in this age group have also supported parents
and caregivers to ensure appropriate television/screen viewing,
encourage active play, establish healthy eating behaviours and diets,
promote healthy sleep routines and role-model healthy caregiver and
family lifestyle (55).
The evidence shows that interventions to improve child nutrition, sleep
and physical activity are most effective if these are comprehensive and
involve caregivers and the community at large (55). Societal changes
and transitions require a more deliberate and concerted interventions,
including support for parents and other caregivers to enable them to
contribute to the recommended behaviour changes.

4.11

Ensure physical activity is

incorporated into the daily
routine and curriculum in
formal child-care settings
or institutions.

4.12

Provide guidance on
appropriate sleep time,
sedentary or screen-time and
physical activity or active
play for the 2–5 years of age
group.

4.13
Engage the whole-of-the-
community to support
caregivers and child-care
settings to promote healthy
lifestyles for young children.

29
 IMPLEMENT COMPREHENSIVE PROGRAMMES
5 THAT PROMOTE HEALTHY SCHOOL
ENVIRONMENTS, HEALTH AND NUTRITION
LITERACY AND PHYSICAL ACTIVITY AMONG
SCHOOL-AGE CHILDREN AND ADOLESCENTS.
School-age children and
adolescents, whether in formal
education or out of school, face
particular challenges. They
are highly susceptible to the
marketing of unhealthy foods
and sugar-sweetened beverages,
peer pressure and perceptions of
ideal body image. Adolescents,
in particular, may have more
freedom in food and beverage
choices made outside the home.
Physical activity often also
declines at this age.
Although a significant number
of school-age children are
unfortunately not in formal
education, the compulsory school
years provide an easy entry
point to engage this age group
and embed healthy eating and
physical activity habits for lifetime
obesity prevention. Given that
governments in most countries
control the education sector,
effective collaboration between
health and education can ensure
that school environments are
healthy environments, where both
nutrition literacy and physical
activity are promoted. To ensure
equity, further attention is needed
to develop programmes to reach
children and adolescents outside
formal education.
There is a growing evidence
base to support interventions for
children and adolescents in school
settings and the wider community
as an obesity prevention strategy
(23). Qualitative assessments
suggest that their effectiveness
on obesity prevention behaviours
and outcomes is related to: a)
quality of implementation; b)
the educational rigour of the
programme and its integration
within mainstream curricula
30
(e.g. reading, science); and c)
positioning of school-based efforts
within the context of broader
educational and community
efforts.
To be successful, programmes
to improve the nutrition and
physical activity of children and
adolescents need to engage with
a number of stakeholders. Obesity
prevention and health promotion
has traditionally been the remit
of ministries of health. Key to
success will be the integration of
activities into a health-promoting
school initiative, with active
engagement of the education
sector. Interventions that will be
incorporated into the school day
or curriculum will then be seen as
part of their own remit. The most
frequently mentioned challenge
to implementation is competition
with the schools’ primary
mission (55). By appropriate
engagement with teachers, such
education can be integrated
effectively into mainstream topics,
rather than requiring separate
time allocation. Collaboration
and exchange of information, the
use evidence-based approaches
appropriately adapted to context,
and resource-sharing between
education and health ministries
will help to move this agenda
forward.
Older children and adolescents
also need to be engaged in the
development and implementation
of interventions to reduce
childhood obesity (56). Only
through their active contribution
in the process will interventions
be shaped to meet their specific
needs, such that they, and their
peers, can fully participate and
benefit.
RECOMMENDATIONS RATIONALE

5.1 Energy-dense, nutrient-poor foods and sugar-sweetened beverages

are important drivers of the obesity epidemic in school-age children
Establish standards for and adolescents globally, acting both to induce and maintain
meals provided in schools, overweight and obesity. It is a paradox to encourage and educate
or foods and beverages children on healthy behaviours, while allowing inappropriate foods
sold in schools, that meet and beverages to be sold or marketed within the school environment.
healthy nutrition guidelines. To establish healthier behavioural norms and make the environment
less obesogenic it is necessary to reduce access to, or provision of,
unhealthy foods and sugar-sweetened beverages in places where
5.2 children gather.
Eliminate the provision or
This strategy must go hand-in-hand with increasing access to,
sale of unhealthy foods,
and promotion of, lower energy density foods and to water as an
such as sugar-sweetened
alternative to sugar-sweetened beverages.
beverages and energy-
dense, nutrient-poor foods,
It may be possible to establish zones around schools where the sale
in the school environment.
of unhealthy foods and beverages is restricted, but the Commission
recognizes that this may not be feasible in a number of settings.
5.3

Ensure access to potable water

in schools and sports facilities.

Understanding the role of nutrition in good health is central to the

5.4
success of interventions to improve diet. As adolescents are the next
Require inclusion of nutrition generation of parents, the importance of health and nutrition literacy
and health education within during adolescence cannot be overestimated – indeed the school
the core curriculum in years and the mainstream curricula offer important opportunities for
schools. progress. Life-course education in schools should be co-constructed
with teachers, according to educational criteria and embedded in
core curricula subjects.
5.5
Effective nutrition literacy goes beyond knowledge to actual behaviour
Improve the nutrition literacy
change. Although there is evidence of the effectiveness of interventions
and skills of parents and
to improve nutrition knowledge and understanding, the impact of these
caregivers.
interventions on dietary behaviour is less clear. Combining nutrition
literacy interventions and clear context-specific nutrition advice to
5.6 children and their caregivers and providing additional knowledge
on food preparation in the context of an improved obesogenic
Make food preparation environment, would enable children, adolescents and their parents/
classes available to children, caregivers to make healthier choices.
their parents and caregivers.

Regular participation in quality physical education and other forms of

5.7 physical activity can improve a child’s attention span, enhance their
Include Quality Physical cognitive control and processing (57). It can challenge stigma and
Education1 in the school stereotypes, reduce symptoms of depression and improve psychosocial
curriculum and provide outcomes. It is important that school-based physical education is
adequate and appropriate inclusive of all children, of all abilities, rather than focused on the
staffing and facilities to potential elite sportsperson.
support this.

1
UNESCO Quality physical education (QPE). Guidelines for policy-makers, Paris 2015.

31
 PROVIDE FAMILY-BASED, MULTICOMPONENT
6 LIFESTYLE WEIGHT MANAGEMENT SERVICES FOR
CHILDREN AND YOUNG PEOPLE WHO ARE OBESE.

When children are already to identify children at risk of

overweight or obese additional
goals include reduction in the
level of overweight, improvement
in obesity-related comorbidities
and improvement in risk factors
for excess weight gain. The
health sector in each country
varies considerably and will
face different challenges in
responding to the need for
treatment services for those
with obesity. However, the
management of children with
overweight and obesity should
be included in effective services
extended under Universal Health
Coverage.
Primary health-care services
are important for the early
detection and management
of obesity and its associated
complications, such as diabetes.
Regular growth monitoring at the
primary health-care facility or at
school provides an opportunity
developing obesity. Low-energy
diets can be effective in the short
term for the management of
obesity, but reducing inactivity
and increasing physical activity
will increase the effectiveness
of interventions. There is little
written on models of health
service delivery for the provision
of obesity treatment in children
and adolescents, but it is clear
that these efforts can only be
effective with the involvement
of the whole family or care
environment.
Health workers and others may
discriminate against children
who are overweight or obese.
All such forms of discrimination
are unacceptable and must be
eliminated (58). The mental
health needs of children,
including issues of stigmatization
and bullying, need to be given
special attention.

RECOMMENDATIONS RATIONALE

Evidence reviews of childhood obesity show that family-focused

6.1
behavioural lifestyle interventions can lead to positive outcomes in
Develop and support weight, BMI and other measures of body fatness. This is the case
appropriate weight for both children and adolescents (59). Such an approach is the
management services for foundation for all treatment interventions. However, very few studies
children and adolescents have been undertaken in low- and middle-income countries.
who are overweight or
obese that are family- For the morbidly obese child, in the face of failure of life-style
based, multicomponent modification, pharmacological and/or surgical options may be
(including nutrition, necessary (60).
physical activity and
psychosocial support) Health professionals and all those providing services to children and
and delivered by multi- adolescents need appropriate training on nutrition and diet, physical
professional teams with activity and the risk factors for developing obesity.
appropriate training and
resources, as part of
Universal Health Coverage.

32
ACTIONS AND RESPONSIBILITIES
FOR IMPLEMENTING
THE RECOMMENDATIONS
The Commission recognizes that successful implementation of the recommendations requires
the committed input, focus and support of a number of agencies. Necessary actions and
responsibilities would involve the following:

WHO

ACTION RATIONALE

It is essential that momentum is maintained to address this complex

A
Institutionalize a cross-
cutting and life-course
approach to ending
childhood obesity across all
relevant technical areas in
headquarters, regional and
country offices.
and critical issue. WHO can lead and convene high-level dialogue
within the United Nations system and with and between Member
States, to build upon the commitments made in the Sustainable
Development Goals, the Political Declaration of the High-level meeting
of United Nations General Assembly on the Prevention and Control
of Non-communicable diseases, the Rome Declaration of the Second
International Conference on Nutrition and others, to address the
actions detailed in this report to end childhood obesity.

Using its normative function, both globally and through its network of
B regional and country offices, WHO can provide technical assistance
by developing or building on guidelines, tools and standards to
Develop, in consultation
support the recommendations of the Commission and other relevant
with Member States, a
WHO mandates at country level.
framework to implement
the recommendations of the
WHO can disseminate guidance for implementation, monitoring and
Commission.
accountability, and monitor and report on progress to end childhood
obesity.
C

Strengthen capacity to
provide technical support
for action to end childhood
obesity at global, regional
and national levels.

D
Support international
agencies, national
governments and relevant
stakeholders in building
upon existing commitments
to ensure that relevant
actions to end childhood
obesity are implemented
at global, regional and
national level.

33
ACTION RATIONALE

Promote collaborative
research on ending childhood
obesity with a focus on the
life-course approach.

Report on progress made on

ending childhood obesity.

International organizations

ACTION RATIONALE

A Cooperation between international organizations including other United

Cooperate to build capacity
and support Member States in
addressing childhood obesity.
Nations agencies can promote the establishment of global and regional
partners and networks for advocacy, resource mobilization, capacity-
building and collaborative research. The United Nations Inter-Agency
Task Force on noncommunicable diseases can support Member States in
addressing childhood obesity.

Members States

ACTION RATIONALE

A Governments hold the ultimate responsibility in ensuring their

citizens have a healthy start in life. Thus, taking an active role to
Take ownership, provide address childhood obesity should not be interpreted as interference
leadership and make political with individual choice, rather as the state taking ownership of
commitment to tackle childhood the development of their human capital. It is clear that to address
obesity over the long term. childhood obesity effectively, the active engagement of multiple
agencies of government is needed. There is an understandable
tendency to see obesity as a problem for the health sector. However,
B
preventing childhood obesity requires the coordinated contributions
of all government sectors and institutions responsible for policies.
Coordinate contributions of
Governments must establish appropriate whole-of-government
all government sectors and
approaches to address childhood obesity. Further, regional and local
institutions responsible for
governments must understand their obligations and harness resources
policies, including, but not
and efforts to ensure a coordinated and comprehensive response to
limited to: education; food;
the issue.
agriculture; commerce and
industry; development;
finance/revenue; sport and
recreation; communication;
environmental and urban
planning; transport and social
affairs; and trade.

34
ACTION RATIONALE

Using these data, governments can establish obesity targets and

C
intermediate milestones, consistent with the global nutrition and
Ensure data collection on noncommunicable disease targets established by the World Health
BMI-for-age of children Assembly. They should include in their national monitoring frameworks
– including for ages not agreed international indicators for obesity outcomes (to track progress
currently monitored – and in achieving national targets), diet and physical activity programme
set national targets for implementation (including coverage of interventions) and the obesity
childhood obesity. policy environment (including institutional arrangements, capacities
and investments in obesity prevention and control). Monitoring
D
should be conducted, to the fullest possible extent, through existing
monitoring mechanisms.
Develop guidelines,
recommendations or policy
measures that appropriately
engage relevant sectors –
including the private sector,
where applicable – to
implement actions, aimed at
reducing childhood obesity,
as set out in this report.

NON-STATE ACTORS
There are many ways in which non-
State actors can play an important
and supportive role in addressing
the challenge of childhood obesity.
As this report shows, the risk school and social environment, by
of childhood obesity is greatly cultural attitudes to body image, by
influenced by food, physical activity the behaviour of adults and by the
and eating behaviours, by the conduct of the private sector.

Nongovernmental organizations

ACTION RATIONALE

A Although building the policy framework is undertaken by government,

Raise the profile of childhood
obesity prevention through
advocacy efforts and the
dissemination of information.
B
in some countries developing nutrition information and education
campaigns, implementing programmes, and monitoring and holding
actors to account for commitments made, may be tasks shared between
government and civil society.
Social movements can engage members of the community and provide
a platform for advocacy and action.

Motivate consumers to demand

that governments support
healthy lifestyles and that
the food and non-alcoholic
beverage industry provide
healthy products, and do not
market unhealthy foods and
sugar-sweetened beverages to
children.

35
ACTION
Contribute to the
development and
implementation of
a monitoring and
accountability mechanism.
The private sector
ACTION
A
Support the production of,
and facilitate access to,
foods and non-alcoholic
beverages that contribute to
a healthy diet.
B The Commission is aware of a number of private sector initiatives that
Facilitate access to, and
participation in, physical
activity.
36
RATIONALE
RATIONALE
The private sector is not a homogeneous entity and includes the
agricultural food production sector, the food and non-alcoholic beverage
industry, retailers, catering companies, sporting-goods manufacturers,
advertising and recreation businesses, and the media. It is, therefore,
important to consider those entities whose activities are directly or
indirectly related to childhood obesity either positively or negatively.
Countries need to engage constructively with the private sector to
encourage implementation of policies and interventions.
have the potential to impact positively on childhood obesity. These need
to be encouraged where they are supported by an evidence base. As
many companies operate globally, international collaboration is vital.
However, attention must also be given to local and regional entities and
artisans. Cooperative relationships with industry have already led to some
encouraging outcomes related to diet and physical activity. Initiatives by
the food manufacturing industry to reduce fat, sugar and salt content,
and portion sizes of processed foods, and to increase the production of
innovative, healthy and nutritious choices, could accelerate health gains
worldwide.
The Commission believes that real progress can be made by constructive,
transparent and accountable engagement with the private sector.
Philanthropic foundations

ACTION RATIONALE

Philanthropic foundations are uniquely placed to make significant

A
contributions to global public health and can also engage in
Recognize childhood obesity monitoring and accountability activities.
as endangering child health
and educational attainment
and thus address this
important issue.

Mobilize funds to support

research, capacity-building
and service delivery.

Academic institutions

ACTION RATIONALE

Academic institutions can contribute to addressing childhood obesity

A
through studies on biological, behavioural and environmental risk factors
Raise the profile of and determinants, and the effectiveness of interventions in each of these.
childhood obesity
prevention through the
dissemination of information
and incorporation into
appropriate curricula.

Address knowledge gaps

with evidence to support
policy implementation.

C
Support monitoring and
accountability activities.

37
MONITORING AND
ACCOUNTABILITY

The greatest risk to effective therefore begin with the adoption currently exist which countries
progress on childhood obesity of meaningful policies that give could draw upon and integrate
is a lack of political commitment clear guidance on the actions into a comprehensive national
and that governments and required and the timeframe for monitoring framework for
other actors will fail to take doing so. childhood obesity. These include
ownership, leadership and the the Global Monitoring Framework
necessary actions. A whole Governments should prioritize for Noncommunicable Diseases1
of society approach offers the investment in building robust and the Global Monitoring
best opportunity for addressing systems with specific indicators Framework for Maternal, Infant
childhood obesity. Both that measure childhood obesity and Young Child Nutrition.2
governments and other actors, and related determinants (such
notably, civil society can hold as fitness and nutrition) in a National strategic leadership
each other and private sector standardized manner. This is includes establishing the
entities to account, to ensure they critical to demonstrating the scale governance structures across
adopt policies and comply with of the problem, providing data a variety of sectors that are
standards. Strong commitments for setting national targets and necessary to manage the
must be accompanied by strong guiding policy development. development and implementation
implementation systems and Well established monitoring of laws, policies and
well-defined accountability systems can provide evidence programmes. National leadership
mechanisms. of the impact and effectiveness is also necessary to manage
of interventions in reducing the engagement with non-State
Governments bear primary prevalence of childhood obesity. actors, such as nongovernmental
responsibility for setting the policy organizations, the private
and regulatory framework for The Commission is aware that sector and academic institutions
the prevention and management governments do not want to to successfully implement
of childhood obesity at the increase the reporting burden. A programmes, activities and
country level. Accountability must number of monitoring mechanisms investments.

1
WHA66.10 Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases
2
WHA68(14) Maternal, infant and young child nutrition: development of the core set of indicators

38
A whole-of-government approach
requires that a clear chain of
responsibility and accountability
is established and that relevant
institutions, tasked with developing
or implementing interventions,
are held accountable for the
performance of those tasks.
Civil society can play a critical
role in bringing social, moral and
political pressure on governments
to fulfil their commitments (61).
Ending childhood obesity should
now form part of civil society’s
agenda for advocacy and
accountability.
The Commission recognizes the
important role the private sector
can play in addressing childhood
obesity but that additional
accountability strategies, including
legal, market-based and media-
based mechanisms (62) are often
necessary. Initiatives of the private
sector (including retailers, food
manufacturers, food services,
insurers) to address obesity that
are supported by an independent
evidence base, should be
considered. Conflict of interest risks
need to be identified, assessed
and managed in a transparent
and appropriate manner. Codes
of conduct and independently
audited assessments of compliance
with government oversight are
therefore important.
Governments can use their
regulatory power to improve the
food environment, to enforce
regulatory standards, to implement
internationally-recognized
standards such as the WHO
International Code of Marketing
of Breast-milk Substitutes,1 and the
WHO Set of Recommendations on
the Marketing of Foods and Non-
alcoholic Beverages to Children.2
Scorecards can be useful tools
in ensuring accountability.
While these examples do not
cover all potential accountability
mechanisms, optimal results will
be achieved by using a mix of
accountability tools and strategies.
The Commission has noted
the important influence that
trade policies can have on the
obesogenic environment. This
is particularly the case for small
island states that are highly
dependent on imported foods
and where the nature of the
food supply and pricing are
largely determined by the trade
dynamics. The Commission
acknowledges the complexity of
international trade, particularly
in food and agricultural products,
but urges Member States and
those involved in international
trade arrangements to seek ways
to address the trade issues that
impact on child obesity.
The greatest risk to
effective progress
on childhood
obesity is a
lack of political
commitment and
that governments
and other actors
will fail to take
ownership,
leadership and the
necessary actions.
1
WHA34.22 International Code of Marketing of Breast-
milk Substitutes.
2
WHA63.14 Marketing of Food and Non-alcoholic
Beverages to Children.
39
CONCLUSIONS

Childhood obesity undermines the physical,

social and psychological well-being of children
and is a known risk factor for adult obesity and
noncommunicable diseases. There is an urgent need
to act now to improve the health of this generation
and the next.

The Commission recognizes that the scope of

potential policy recommendations to address
childhood obesity is broad and contains a number
of novel elements. However, it is only by taking a
multisectoral approach through a comprehensive,
integrated package of interventions that address the
obesogenic environment, the life-course dimension
and the education sector, that sustained progress can
be made. This requires government commitment and
leadership, long-term investment and engagement of
the whole of society to protect the rights of children to
good health and well-being. The Commission believes
that progress can be made if all actors remain
committed to working together towards a collective
goal of ending childhood obesity.

40
41
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 CHILDHOOD OBESITY
UNDERMINES THE
PHYSICAL, SOCIAL AND
PSYCHOLOGICAL WELL-
BEING OF CHILDREN
AND IS A KNOWN
RISK FACTOR FOR
ADULT OBESITY AND
NONCOMMUNICABLE
DISEASES. THERE IS
AN URGENT NEED TO
ACT NOW TO IMPROVE
THE HEALTH OF THIS
GENERATION AND
THE NEXT.

45
ANNEX 1:
THE COMMISSION
ON ENDING
CHILDHOOD OBESITY
The prevalence of infant, childhood
and adolescent obesity is
increasing in many countries, with
the most rapid rises occurring in
low- and middle-income countries.
Without intervention, obese infants
and young children are likely
to continue to be obese during
childhood, adolescence and
adulthood.
Childhood obesity is associated
with a wide range of health
complications and an increased
risk of premature onset of
illnesses, including diabetes and
heart disease. Many causes and
potential solutions to this problem
exist. However, as is the case
with all public health strategies,
there are many challenges to
implementation. Only through
a combination of community
partnerships, government support
and scientific research will the best
recommendations be developed
and implemented worldwide.
In order to better inform and
fashion a comprehensive response
to childhood obesity, the WHO
Director-General established
a high-level Commission on
Ending Childhood Obesity,
comprising fifteen accomplished
46
and eminent individuals from a
variety of relevant backgrounds.
The Commission was tasked with
preparing a consensus report
specifying the approaches and
combinations of interventions
that are likely to be most effective
in tackling childhood and
adolescent obesity in different
contexts around the world. The
Commission reviewed, built upon
and addressed gaps in existing
mandates and strategies on the
prevention of childhood obesity.
The work of the Commission was
supported by two ad hoc working
groups for ending childhood
obesity – one on the science
and evidence, and the other on
implementation, monitoring and
accountability.
The Commission held four meetings
and, as part of its working
methods, undertook regional
consultations with Member States
as well as hearings with non-
State actors. The first meeting
took place in Geneva on 17 and
18 July 2014, during which the
Commission reviewed the report
of the first meeting of the Ad hoc
Working Group on Science and
Evidence and developed its method
of work.
During the second meeting, held
in Geneva on 13 and 14 January
2015, the Commission reviewed
the second report of the Ad hoc
Working Group on Science and
Evidence and the first report of
the Ad hoc Working Group on
Implementation, Monitoring and
Accountability, and developed the
Interim Report of the Commission
on Ending Childhood Obesity.
This provided the rationale for
tackling childhood obesity and the
imperative for governments to take
the lead in addressing the issue.
The Interim Report highlighted
potential policy options for tackling
the obesogenic environment,
reducing the risk of obesity by
addressing critical elements in
the life-course approach and the
management of children with
obesity to improve their current and
future health.
The Interim Report also served as
the basis for an online consultation
from 16 March to 5 June 2015.
Eighty-one entities, including
Member States, nongovernmental
organizations, philanthropic
foundations, academia,
researchers, the private sector and
individuals submitted comments on
the Interim Report.
THE
COMMISSION
ALSO HELD
SEVEN
REGIONAL
CONSULTATIONS
WITH MEMBER
STATES:
The Commission convened its
third meeting on 22 and 23 June
2015 in Hong Kong Special
Administrative Region, Republic
of China. During this meeting
the Commission reviewed the
comments received from Member
States on agenda item 13.3 at
the 68th World Health Assembly,
the feedback received from
the online consultations as well
as the regional consultation
and hearings with the Western
Pacific mainland countries. The
Commission also received from
the WHO Director-General a
report of the second meeting of
MANILA
The Philippines
24/25 March
for the Western Pacific
Region mainland
countries
AUCKLAND
New Zealand
27/28 July
for the Western Pacific
Region Island Countries
and Territories
NEW DELHI
India
28/29 September
for the South-East Asia
Region countries
VALLETTA
Malta
28/29 October
for the European
Region countries
the Ad hoc Working Group on
Implementation, Monitoring and
Accountability and an evidence
update from the Ad hoc Working
Group on Science and Evidence.
At the third meeting, the
Commission developed its
final draft report detailing
potential policy directions for the
consideration of Member States.
The draft final report served as the
basis for regional consultations
for the Region of the Americas,
South-East Asia Region, African
Region and European region. The
report was also placed online
CAIRO
Egypt
2/3 July
for the Eastern
Mediterranean Region
countries
MEXICO CITY
Mexico
26/28 August
for countries of the
Region of the Americas
ACCRA
Ghana
22/23 October
for the African Region
countries
from September to November
2015 for comments by relevant
stakeholders; 98 submissions
were received and reviewed.
Following the period of
consultations, the Commission held
its fourth meeting in Geneva on
30 November and 1 December
2015, to review the feedback
received, consider the reports of
the two ad hoc working groups
and develop their final report. This
final report of the Commission on
Ending Childhood Obesity will be
submitted to the WHO Director-
General in January 2016.
47
ANNEX 2:

COMMISSIONERS

Sir George Alleyne Ms Betty King Professor Hoda Rashad

Director Emeritus Former Ambassador Research Professor and Director
Pan American Health Permanent Mission of the Social Research Center
Organization (PAHO) United States of America to the American University in Cairo
United Nations Office and other Egypt
Dr Constance Chan Hon Yee International Organizations at
Director of Health Department Geneva Professor K. Srinath Reddy
of Health Hong Kong Special President Public Health
Administrative Region Ms Nana Oye Lithur Foundation of India Institute of
China Minister of Gender, Children and Studies in Industrial Development
Social Protection (ISID) Campus
Ms Helen Clark Ghana India
Administrator
United Nations Development Dr David Nabarro Dr Jacques Rogge
Programme Coordinator, Scaling up Honorary President International
(UNDP) Nutrition (SUN) Movement Olympic Committee (IOC)
Special Representative of the Switzerland
Sir Peter Gluckman UN Secretary General for
(co-chair) Food Security and Nutrition Ms Sachita Shrestha
Chief Science Advisor to the Coordinator for the High Level Youth Advocate
Prime Minister of New Zealand Task Force Nepal
& Liggins Institute University of
Auckland Dr Sania Nishtar (co-chair) Dr Colin Tukuitonga
New Zealand Founder, Heartfile Director-General
Pakistan Secretariat of the Pacific
Mr Adrian Gore Community (SPC)
Founder and Chief Executive Officer Ms Paula Radcliffe New Caledonia
Discovery Group Athlete and parent
South Africa United Kingdom

48
49
Photo credits
Cover:
© 2007 Iryna Shabaykovych, Courtesy of Photoshare
© 2013 Valerie Caldas/ Johns Hopkins University Center
for Communication Programs, Courtesy of Photoshare
© 2013 Alissa Zhu, Courtesy of Photoshare

P. xiv © WHO / SEARO /Payden

P. 5 © 2014 Jose Ramos II, Courtesy of Photoshare
P. 6 © 2008 Pablo P Yori, Courtesy of Photoshare
P. 9 © 2007 Jose M. Marin, Courtesy of Photoshare
P. 10 © 2008 Kunle Ajayi, Courtesy of Photoshare
P. 13 © 2014 Lorine Ghabranious/MSH, Courtesy of Photoshare
P. 15 © 2013 Anil Gulati, Courtesy of Photoshare
P. 16 © 2012 Sharvari Raval, Courtesy of Photoshare
P. 23 © 2013 Kyle Sherman, Courtesy of Photoshare
P. 25 © WHO / SEARO /SB Rai
P. 26 © WHO / SEARO /Anuradha Sarup
P. 27 © WHO / SEARO /SB Rainow
P. 29 © 2013 Valerie Caldas, Courtesy of Photoshare
P. 37 © 2013 David Huamaní, Courtesy of Photoshare
P. 39 © 2012 David Snyder for CRWRC, Courtesy of Photoshare
P. 41 © 2005 Anil Gulati, Courtesy of Photoshare
P. 49 © 2011 Lawrence Ko, Courtesy of Photoshare

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www.who.int/end-childhood-obesity/en